Managing Healthcare Efficiently: An Observation on Operations and Management of Intellicare, The Medical City

Submitted in partial fulfillment of the Transition Summer Program and Management Dynamics

by Casauay, Gabriel Co, Elaine Dela Cruz, Katrina Gana, Joanna Ramos, Julienne Viray, Joseph

to Maloy Almeda-Benito, MBA on April 2, 2013

Introducing the Organization: IntelliCare IntelliCare, previously known as ASALUS Corporation, began operations as a health maintenance organization in 1995. Today, IntelliCare is among the top three HMOs in the Philippines, and continues to seek quality healthcare delivery that is affordable, accessible, and available, to individuals. IntelliCare also stresses the importance of a holistic approach to healthcare management, which includes the prevention, treatment, and management. IntelliCares Mission and Vision are as follows: We are the country's PREEMINENT HMO, committed to lead, innovate, and trailblaze a holistic approach to healthcare management. As the HMO of FIRST CHOICE, all our endeavors and aspirations shall constantly adhere to the highest level of ethical and performance standards, guided by our company's long-standing principles of integrity, fairness, honesty, hard work, and an enduring sense of humanity. The end in view of this commitment is and shall always be the upholding of the right of each individual to health by making quality healthcare efficient, accessible, affordable, and compassionate. The main objective of IntelliCare is to manage the health care of enrolled individuals, and to provide them with health insurance. Currently, IntelliCare only accepts proposals from corporate accounts, which means that employees of a client company are able to avail of IntelliCares services. IntelliCare is able to manage corporate accounts in two different ways: through the Health Maintenance Organization Program, and the Third Party Administration. In the HMO program, employees of the corporate clients can gain access to IntelliCares medical providers based on fixed and periodical payments agreed upon by both the corporate client and IntelliCare (premium). Under this program, there are Account Officers available to handle the concerns of the clients, and a Wellness Programs for the clients wants and needs. This program is the most common form of health insurance, where the HMO pays for the medical services of health professionals and institutions on behalf of the patients, but only to those professionals and institutions accredited with them, having a mutual benefit of continuous supply of patients for doctors and hospitals, and bulk discounts for the HMO. The type and amount of medical services
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and other financial assistance provided in the HMO program is dependent upon the type of package or plan the client company has availed from Intellicare for its employees. Under the Third Party Administration program, the corporate client deposits a Health Fund on behalf of the enrolled members. This fund is used by IntelliCare for payment of health care services and benefits that have been availed. The Health Fund is replenished by clients to ensure that the amount does not fall under the agreed amount. In this program, clients only pay for health services and benefits that have been availed, as opposed to a periodic payment. Intellicare collects administration fees for managing the healthcare of the enrolled members, and exclusively uses the Fund given by the company. The company benefits from this program by availing of the bulk discounts that Intellicare has. Through Intellicare, the company theoretically spends less on medical bills because they pass through Intellicare, which is given different rates by accredited health professionals and institutions. Intellicare directly employs around one thousand people, who work with a network of over 14,000 physicians, specialists, and nurses, from over 900 accredited medical facilities in Luzon, Visayas, and Mindanao. To manage a well-coordinated company like IntelliCare across the whole country, a complex hierarchical structure is employed. The chairman of the board, the board members, and several key officers each have essential roles for IntelliCares smooth operations. Key officers include the President, the Medical Director, Senior Vice Presidents of Sales and Marketing, Operations, Finance, Vice Presidents of Sales and Marketing, Human Resources Management and Development, Operations, and Visayas and Mindanao Operations. There are Associate Vice President positions as well, for Facilities and Properties Administration, Internal Audit, Sales, Corporate Social Responsibility, Membership Services, Accounting, Account Management, and Treasury. These people represent the top-level management of the company, who in turn handle middle-managers such as the one studied in this paper, and staff underneath them.

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Observation: The Medical City Branch The present assignment to the researchers involves conducting research on the organization, as well as an observation of the day-to-day operations of a branch in particular. The group chose the Intellicare branch situated within the Medical Arts Tower of The Medical City, which is one of their many administrative offices in different locales and medical institutions. The observation was done on the 30th of April, 2013 with all researchers in attendance. General observations The branch has a well-organized reception area, complete with a ticketing system for more efficient queuing. There are entertainment materials and a television for those waiting in line. There are two clinics/consultation rooms within the office which some patients utilize for check-ups. The branchs primary function is to represent the HMO during billing, reimbursements and other transactions concerning the medical procedures received by their clients, especially with The Medical City and affiliated doctors within the hospital. They assess whether clients can claim a benefit based on their coverage plans. If patients are eligible, they are provided with a letter of authorization that serves as the payment for the medical procedures that they receive. Other than that, an out-patient clinic which has consultation, vaccination and minor surgery services from different specializations like Ob-Gyn, Pediatrics, IM, Gastroenterology, ENT, and others. The doctors providing these services come in and see patients on a regular basis, but are not on the direct employ of Intellicare. TMC Intellicares eleven-hour workday begins at 7:00 am and ends at 6:00 pm. Between this time, there is a constant flow of patients served by the branchs staff of seven. The volume of patients reaches 600-700 on peak days (Mondays, Fridays, and Saturdays) and 250-400 on off days. These patients can either be those coming in for a medical consultation inside the premises, or those who are there to transact with Intellicare for other types of benefits. The seven employees working at the branch are divided into three divisions; Customer Support (3), Liaison (2), and Nursing Staff (2). All of them are technically of the same rank as each other, and it is important to note that there are no managers present in the branch to oversee operations on a daily basis. All of the staffs immediate superiors are located in

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Intellicares head office, and is available via telephone. The routine operation of the branch are dealt with by the staff without immediate supervision. This daily routine is guided by a well established system that incorporates billings, patient consultations and doctor referrals that have been entrenched in the staff, who therefore work with precision and efficiency. A good communication infrastructure is evident, as this is what enables the staff to be in constant connection with the head office where the managers are located. This was made so that when problems arise, it is easy to consult their superiors. This type of approach requires that employees are chosen and trained well, such that teams can efficiently and effectively function even without the physical presence of a manager in the branch. Upon observation it seems that upper management has planned and organized a solid system for efficient workers, and middle management has trained their people well for the job. This results to efficient operations, as proven by the volume of patients served in a day, despite being staffed by a number less than 10. Staff effectivity is not only visible from the amount of people they are able to serve each day, but through the high retention rate of the company, estimated at 90%. This is made possible by front-line staff such as those manning the TMC branchs good relational skills. Plus, nnot only are they able to serve clients well, they are also able to work well together despite not having a manager present in the facility. Finally, being in the business of providing service through health insurance, it is important for Intellicare to give importance to creating and maintaining good relationships with clients, who are, after all, medical patients. Part of this effort is bringing the company closer to patients, that is why branches are strategically located inside major hospitals, as is the case for this particular branch.

Objective of operations Dispensation of Benefits The TMC Intellicare administrative offices main objective is to facilitate the dispensation of benefits to members in a strategic location such as in a hospital. Therefore, it acts as the liaison between patients and doctors, especially in a financial capacity. Clients and their

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beneficiaries come to Intellicare to handle the consultation fees and other medical expenses covered by their program. This is handled by the Customer Support team. The TMC Intellicare also acts as a liaison between confined patients and the hospital or other healthcare providers through the Liaison officers. These officers visit patients in their room, update them with the state of their confinement and how Intellicare may help with the situation. They also handle the paperwork and other documentation between The Medical City and Intellicare, bringing convenience to the patient. Lastly, the clinics within the TMC Intellicare allows consultation and check-up benefits to be availed directly from Intellicare, thereby reducing unnecessary red-tape and increasing convenience for both the company and the patients. The patients are also ensured of a doctor whose fees will be shouldered by Intellicare, as well as doctors who pass the standards Intellicare sets for a high quality of healthcare. Collecting Information The TMC Intellicare branch is also a way for the head office and higher officials to gather information about their clients. Monthly reports from the TMC Intellicare staff, forwarded to the head office, are used to control the management of the company. The staff also provides their superiors and other managers information about the patients, as they are the ones that directly interact with them. To collect this information is an important objective for the branch because it is what allows management to make decisions based on whats happening, whats working, and what else is needed. Presence of a manager As was mentioned, each branch is run by a team. There is no constant supervision from a higher-ranked officer. The customer representatives, nurses and liaison officers each have their own tasks and routines. However, if a problem arises, they can simply consult their superiors who are located in the head office on what actions to take. Therefore, there are individuals who lead and manage the operation but they arent physically present in the administrative offices at all times. They are simply there to provide advice when necessary.

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Interview with an Intellicare employee The key informant interviewed by the team was Sir Ram, who worked under the Customer Support division of the branch. Like his colleagues on the same division, he is in charge of dealing with patients who come for administrative issues, dissemination information to them on behalf of Intellicare, and managing their out-patients papers such as distributing Letters of Authorization. As was previously discussed, he is in the same hierarchichal level as all his coworkers in the same branch, which is not of a managerial nature. He has therefore agreed to supply information about how their branch is managed by the head office through his immediate supervisor, the Customer Support (CS) Manager (name withheld).

Managerial Roles The following information on the managerial roles and activities performed by the the Customer Support Manager are taken from Sir Rams interview. 1. He embodies the role of Monitor through monthly meetings between the head office and the branches. Such information is used to assess performance and status of the branches in terms of clients who avail of Intellicares services. He is then able to make corrections upon the work of Sir Ram and the rest of the Customer Support staff. It is also in his role as Monitor that he conducts surprise visits to make sure that the center is running smoothly and properly, and that the objectives of the company as well as this particular branch are being met. 2. He is also a Disseminator, as seen in the reports sent to higher-level managers about branch operation, such as statistics on the number of patients served, the types of services availed, and other information from the branch itself. He also does this function in the opposite direction, wherein he disseminates company policies and other regulations from the head office and upper management to the branch staff. 3. As a Leader, he is in charge of overseeing the training of his staff, which the researchers have concluded is good enough that the branch personnel are able to efficiently run the center without superiors physically present. He is also knowledgeable in the techniques involved in doing Customer Support work, as well as the company regulations that back these techniques up. This allows his staff to come to him for any problem they might not
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be equipped to handle. It is also in his capacity as a Leader that he comes and works personally in the center with the rest of his staff when they are few in number/understaffed. This boosts the confidence of an otherwise overwhelmed staff. 4. The Customer Support Manager is also an important Liaison. The links between the head office and the branches are constantly maintained in order to provide a constant flow of information and reports, which enables smooth operations. In one particular example, the HR departments of client companies often give endorsements for certain VIPs or special cases that need some finesse in handling. The CS Manager hands down this endorsement to the branch, who are then expected to carry out the requests. In the same vein, he also represents TMC Intellicare to upper management such that any concerns from the branch reaches the head office through the CS manager. 5. Lastly, Sir Ram has also stated that his boss is frequently a Disturbance Handler - As previously mentioned, he handles concerns and issues that are brought up by employees, such as irate patients and those who are pushing to receive certain benefits that they are not entitled to. The Customer Support Manager handles cases which Sir Ram and the others are unable to.

Managerial Skills Given the aforementioned roles and responsibilities of the Customer Support manager, the managerial skills needed are mostly technical skills and human skills. Technical skills are needed in this position because knowledge on the companys procedures, policies, and the like are the kinds of issues branch employees like Sir Ram, may need further assistance in. He is also skilled in the kind of work that his subordinates are engaged in, such as relating to patients, which makes him a natural leader to his Customer Support staff. Human skills are also necessary because the Customer Support manager acts as the middleman between the branches and the main offices, and it is his policy to have monthly meetings with the branch employees. These functions will not be successful without the ability to relate to his staff, like listening to the problems of Sir Ram and the others. Because there is a well-established system in place, the employees of this particular IntelliCare branch are able to perform their jobs smoothly and, as shared by the CS personnel we interviewed, hardly do they
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encounter work-related problems. Sir Ram also mentioned that one of the best things about his job is having a good, friendship-like relationship with his officemates, which the Customer Support manager actively promotes.

Management Issues and Functions of Management An issue brought up by the staff during one of their monthly meetings was the lack of an adequate queue management system. With daily customers reaching the high hundreds, an increase in customer waiting time and frustration was inevitable, thereby making the branch service delivery less efficient. The branch employees superiors in the main office was fortunately able to address this issue by employing a priority numbering system. This issue was resolved through careful planning, organizing, leading, and controlling of the managers in IntelliCare. Planning involves setting goals and objectives, which in this case, is the provision of efficient and effective service. Organizing entails assignments of tasks. The personnel shared that managing the queue prevented others from performing their actual tasks efficiently. By putting a number system in place, the task of accommodating customers in a first come first served basis, would result in an improved efficiency within the branch staff, making operations more swiftly. Leading, or motivating employees to perform well, is apparent in IntelliCare when the employees suggest ways in which the branch may be able to function better. Their suggestions and feedback for current operations are welcome during monthly meetings in the head office. These meetings also serve as a way for IntelliCare management to control, or monitor and evaluate the branch operations and the employees performances. Another problem that the employees encounter almost daily is dealing with irate customers, most of whom are complaining about deprivation of certain benefits that they believe they are entitled to. The CS personnel shared that most of these complaints stem from the fact that these customers are not very familiar with their own insurance plan. Usually, the CS representatives handle these issues themselves by providing customers with apt explanations. Because no authoritative figure is physically present in the branch, difficult cases (very insistent customers), are handled by contacting the head office so as to consult their superiors on a decision regarding the matter.

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Synthesis: Management and Health Care Our observations and interviews in IntelliCare further demonstrated that health care would be far more effective if it were to go hand in hand with management skills. IntelliCare exhibited that a unit can function independently without much supervision from superiors, given that they are trained for their respective jobs properly. If management skills can be taught in local levels such as in barangay health centers, primary health care can be delivered more effectively and efficiently, which means more patients can be accommodated. Doctors must also be careful that an increasing number of patients does not come at the expense of the quality of the health care being delivered. Having management skills would also be useful in determining how to meet the needs of each patient, while maintaining the planned quality for the care. With a background in management, doctors and health workers will also be able to see health care in a more holistic approach - understanding things and people not only in the clinical sense, but also paying attention and being aware of social realities. Proper resource collection and allocation would allow patients to seek the quality health care they deserve, without financial constraints becoming an issue. Health care financing, such as IntelliCare, is just one of many ways in which health care can be obtained without shelling out too much money at once. Health management organizations alleviates this problem to a degree. Possible challenges we can encounter as managers in the healthcare industry includes the acceptance that doctor-managers dont work as individuals, but as teams. Another is the need to balance being a doctor with being a manager. Because management is closely associated to marketing and the profit, doctors shouldnt see patients as merely an opportunity to earn more money. Lastly, it is wise to turn back to some of the insights we have gleaned from our observation of the HMO industry, that while HMOs do help out certain individuals shoulder potentially expensive medical expenses, it is still largely dependent on being employed by a company aware enough to buy them insurance or having enough foresight to avail of it privately. In effect, healthcare is still largely tied to ones economic status. A manager in the health industry is therefore faced with the problem of making healthcare accessible to everyone.

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Sources
Text and Photographs from: Intellicare - Your Intelligent Health Choice." Intellicare - Your Intelligent Health Choice. http://www.intellicare.com.ph/ (accessed April 29, 2013). Intellicare, https://www.facebook.com/intellicare Daft, Richard L.. The New Era of Management. International ed. Mason, Ohio: Thomson/SouthWestern, 2006. Almeda-Benito, Maloy, MBA. "Introduction to Management." Class lecture, MBA Module from Ateneo School of Medicine and Public Health, Pasig City, April 29, 2013.

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